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Abstract Background Associations between perceived and actual risk of HIV infection and HIV prevention services uptake are inconclusive. This study aimed to evaluate the discrepancy between the perceived and actual HIV risk, and quantify the associations between perceived and actual risk of HIV infection and three HIV prevention services utilization among men who have sex with men (MSM) in Shandong province, China. Methods A cross-sectional study was conducted in Shandong province in June 2021. Participants were eligible if they were born biologically male, aged 18 years or older, had negative or unknown HIV status, and had sex with men in the past year. Participants were recruited online. The discrepancy between their perceived and actual risk of HIV infection was evaluated by calculating the Kappa value. Bayesian model averaging was used to assess the associations between perceived and actual risk of HIV infection and HIV prevention services uptake. Results A total of 1136 MSM were recruited, most of them were 30 years old or younger (59.9%), single (79.5%), with at least college education level (74.7%). Most participants (97.4%) perceived that they had low risk of HIV infection, and 14.1% were assessed with high actual risk. The discrepancy between their perceived and actual risk of HIV infection was evaluated with a Kappa value of 0.076 (P

ObjectiveTo explore the intervention effects of different social media platforms on improving the knowledge of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) diagnosis and treatment among HIV-positive men who have sex with men (MSM). MethodsA total of 288 HIV-positive MSM were recruited at the Shandong Provincial Public Health Clinical Center from October to December 2020, and according to their preference, the MSM were divided into three groups to receive information on the knowledge and practice of HIV/AIDS diagnosis and treatment via short message service (SMS), WeChat, and the combination of WeChat and QQ group in six months. The generalized estimating equation used to analyze and compare the intervention effects of the interventions via different social media on the overall knowledge score of HIV/AIDS diagnosis and treatment among the all and subgroups of the participants. ResultsThe mean age of the participants was 34.67 ± 9.22 years. Six-month follow-up showed that the total score of HIV/AIDS diagnosis and treatment knowledge in the WeChat intervention group was 0.38 points higher than that in the SMS intervention group (P = 0.01), and there was no significant difference between the results of the other intervention groups (P > 0.05); in the subgroup with high school education and below, WeChat intervention (P = 0.018), WeChat and QQ group intervention (P = 0.002) were better than SMS intervention in improving the total score of AIDS diagnosis and treatment knowledge. ConclusionCompared with SMS intervention, WeChat intervention significantly improved the HIV/AIDS diagnosis and treatment knowledge score of HIV-positive MSM, and WeChat can be used as the main media for HIV-positive MSM to popularize HIV/AIDS knowledge in the future.

Objective This study aimed to compare the effectiveness of instant versus text messaging intervention (TMI) on antiretroviral therapy (ART) adherence among men who have sex with men (MSM) living with HIV. Methods This study was conducted in an infectious disease hospital of Jinan, China from October 2020 to June 2021, using non-randomized concurrent controlled design to compare the effectiveness of instant messaging intervention (IMI) versus TMI. The intervention strategies (health messaging, medication reminder, and peer education) and contents were consistent between the two groups, and the difference was service delivery method and type of information. The primary outcome was the proportion of achieving optimal ART adherence, defined as never missing any doses and delayed any doses more than 1 hour. Results A total of 217 participants (including 72 in TMI group and 145 in IMI group) were included in the study. The proportion of achieving optimal adherence was higher in IMI group than TMI group at the first follow-up (90.2% versus 77.6%, p = 0.021) and second follow-up (86.5% versus 76.6%, p = 0.083). The effect of IMI versus TMI on improving ART adherence was found not to be statistically significant (risk ratio (RR) = 1.93, 95% confidence interval (CI): 0.95–3.94) in complete-case analysis. However, when excluding participants who did not adhere to the interventions, a significant improvement was observed (RR = 2.77, 95%CI: 1.21–6.38). More participants in IMI group expressed highly rated satisfaction to the intervention services than those in TMI group (67.3% versus 50.0%). Conclusions The IMI demonstrated superior efficacy over TMI in improving ART adherence and satisfaction with intervention services. It is suggested that future digital health interventions targeting ART adherence should prioritize instant messaging with multimedia information in areas with Internet access. Trial registration The study was registered at the Chinese Clinical Trial Register (ChiCTR), with number [ChiCTR2000041282].

BackgroundThe HIV infection status among men who have sex with men (MSM) in China is a cause for concern. Post-exposure prophylaxis (PEP) serves as a highly effective biomedical preventive measure against HIV infection. Substantial evidence has established an association between PEP utilization and risk behaviors among MSM, but whether the utilization of PEP has an impact on risk behaviors remains unknown. This study sought to elucidate the impact of PEP usage on risk behaviors among MSM and provide recommendations for developing targeted HIV prevention programs.MethodsA cohort study was conducted in Qingdao, China, from April 2021 to January 2022. Participants were enlisted by volunteers from community-based organizations through a snowball sampling method. Face-to-face interviews were conducted to collect sociodemographic and behavioral information of participants. The study encompassed a retrospective investigation, baseline survey, and follow-up survey, representing periods before, during, and after PEP usage, respectively. Generalized estimating equations, fitting a Poisson regression model, were applied to scrutinize changes in risk behaviors of MSM during and after PEP usage, in comparison to before PEP usage.ResultsA total of 341 MSM were recruited in the cohort study, with 179 individuals completing the follow-up survey. In comparison to before PEP usage, there was a significant increase in the proportion of Rush Popper usage (17.6% vs. 23.8% vs. 29.6%) and commercial sexual partners (10.9% vs. 17.6% vs. 21.8%) among MSM during and after PEP usage. Before PEP usage, 88.7% of MSM reported having ≥3 temporary sexual partners in the last 6 months. This proportion exhibited no significant change during PEP usage (91.8%), but it significantly increased to 97.8% after PEP usage (P < 0.05). Notably, there was a significant decrease in group sex during and after PEP usage compared to before PEP usage (30.8% vs. 21.4% vs. 21.2%).ConclusionThe utilization of PEP may impact risk behaviors among MSM, potentially leading to increased Rush Popper usage, temporary sexual partners, and commercial sexual partners after PEP usage, accompanied by a decrease in group sex. Further research is imperative to elucidate the impact of PEP utilization on MSM and develop targeted HIV prevention programs.

ObjectiveTo investigate the prevalence and influencing factors of sexually transmitted diseases (STD) among men who have sex with men (MSM) in Shandong province.MethodsUsing snow bowling, one site and online sampling methods, we recruited 4 416 MSM aged ≥ 16 years and having insertive oral or anal sex during past six months in 11 STD sentinel surveillance sites across Shandong province. Face-to-face interview with an unified national questionnaire was conducted among the participants during April – July 2022 to collect participants′ information on sociodemographics, STD, STD-related sexual behaviors and intervention acceptances. Multivariate logistic regression were used to analyze influence factors of STD infection.ResultsSuffering from STD in the past one year was reported by 236 (5.34%) of the participants; of the STD sufferers, 51.3% (121) had syphilis and 23.7% (56/236) had Condyloma acuminatum (CA). Multivariate logistic regression showed that the participants with following characteristics were at an increased risk of STD infection: aged > 35 years (odds ratio [OR] = 1.697, 95% confidence interval [95%CI]: 1.046 – 2.755), with education of college or above (OR = 2.696, 95%CI: 1.131 – 6.425), having moderate cognition on the hazards of drug abuse (OR = 11.746, 95%CI: 1.523 – 90.568) or having higher cognition on the hazards of drug abuse (OR = 12.335, 95%CI: 1.645 – 92.496), having commercial homosexual behavior during last 6 months (OR = 2.273, 95%CI: 1.477 – 3.498), ever having group sex (OR = 1.693, 95%CI: 1.149 – 2.494), and ever taking pre-exposure prophylaxis (PrEP) (OR = 1.807, 95%CI: 1.100 – 2.967); while seeking homosexual partner via internet/dating software was a protective factor against STD infection (OR = 0.486, 95%CI: 0.271 – 0.871).ConclusionAmong MSM in Shandong province, the prevalence of STD, mainly syphilis and CA, is high and high-risk sexual behaviors and ever taking PrEP are risk factors for STD infection; the results suggest that more effective and targeted intervention measures should be developed among the MSM.

BackgroundMen who have sex with men (MSM) have a high prevalence of HIV and a low rate of HIV testing in China. HIV self-testing (HIVST) presents a viable strategy for expanding HIV testing among MSM. However, the impact of HIVST on risk behaviors among MSM remains controversial. Our study sought to ascertain this impact.MethodsFrom April 2021 to January 2022, a mixed-methods study was conducted in Qingdao City, employing both quantitative and qualitative methodologies. The quantitative component entailed a cohort study among MSM who had used HIVST. Generalized estimating equations fitting Poisson regressions were used to analyze the changes in risk behaviors of MSM in short time after HIVST (ST-HIVST) and longer time after HIVST (LT-HIVST) compared to before HIVST. Subsequently, we conducted in-depth interviews with 18 MSM who completed the follow-up to delve deeper into the impact of HIVST on MSM.ResultsA total of 410 MSM were recruited in the cohort, of whom 83 were lost to follow-up. Compared to before HIVST, there were no significant changes in risk behaviors in ST-HIVST (p > 0.05), while the proportion of recreational drugs abuse (20.7% vs. 33.3%), commercial sex (14.6% vs. 22.9%), and unprotected anal sex (95.9% vs. 98.5%) increased significantly in LT-HIVST (p

BackgroundDespite great efforts in HIV prevention worldwide, HIV testing uptake among men who have sex with men (MSM) remains suboptimal. The effectiveness of digital, crowdsourced, multilevel interventions in improving HIV testing is still unclear. ObjectiveThe aim of this study was to evaluate the effect of a digital, crowdsourced, multilevel intervention in improving HIV testing uptake among MSM in China. MethodsWe conducted a 2-arm cluster randomized controlled trial among MSM in 11 cities in Shandong province, China, from August 2019 to April 2020. Participants were men who were HIV seronegative or had unknown serum status, had anal sex with a man in the past 12 months, and had not been tested for HIV in the past 3 months. Participants were recruited through a gay dating app and community-based organizations from preselected cities; these cities were matched into 5 blocks (2 clusters per block) and further randomly assigned (1:1) to receive a digital, crowdsourced, multilevel intervention (intervention arm) or routine intervention (control arm). The digital multilevel intervention was developed through crowdsourced open calls tailored for MSM, consisting of digital intervention images and videos, the strategy of providing HIV self-testing services through digital tools, and peer-moderated discussion within WeChat groups. The primary outcome was self-reported HIV testing uptake in the previous 3 months. An intention-to-treat approach was used to examine the cluster-level effect of the intervention in the 12-month study period using generalized linear mixed models and the individual-level effect using linear mixed models. ResultsA total of 935 MSM were enrolled (404 intervention participants and 531 controls); 751 participants (80.3%) completed at least one follow-up survey. Most participants were younger than 30 years (n=601, 64.3%), single (n=681, 72.8%), had a college degree or higher (n=629, 67.3%), and had an HIV testing history (n=785, 84%). Overall, the proportion of testing for HIV in the past 3 months at the 3-, 6-, 9-, and 12-month follow-ups was higher in the intervention arm (139/279, 49.8%; 148/266, 55.6%; 189/263, 71.9%; and 171/266, 64.3%, respectively) than the control arm (183/418, 43.8%; 178/408, 43.6%; 206/403, 51.1%; and 182/397, 48.4%, respectively), with statistically significant differences at the 6-, 9-, and 12-month follow-ups. At the cluster level, the proportion of participants who had tested for HIV increased 11.62% (95% CI 0.74%-22.5%; P=.04) with the intervention. At the individual level, participants in the intervention arm had 69% higher odds for testing for HIV in the past 3 months compared with control participants, but the result was not statistically significant (risk ratio 1.69, 95% CI 0.87-3.27; P=.11). ConclusionsThe intervention effectively improved HIV testing uptake among Chinese MSM. Our findings highlight that digital, crowdsourced, multilevel interventions should be made more widely available for HIV prevention and other public health issues. Trial RegistrationChinese Clinical Trial Registry ChiCTR1900024350; http://www.chictr.org.cn/showproj.aspx?proj=36718. International Registered Report Identifier (IRRID)RR2-10.1186/s13063-020-04860-8

Abstract Background Research on the relationship between disclosure of HIV status to male sexual partners (HIV disclosure) and quality of life (QOL) revealed complex and even contradictory results. The impact of HIV disclosure on various domains of QOL and the mediation effect between them are unclear. The purposes of this study were to explore the impact of HIV disclosure on QOL among men who have sex with men (MSM), and whether HIV treatment self-efficacy mediated these relationships. Methods The data came from a baseline survey on the design of a randomized control trial conducted in Shandong, China. A total of 579 MSM patients were included. SPSS 24.0 was used to conduct independent samples t test, one-way analysis of variance and nonparametric tests and the PROCESS macro was used to conduct mediation analysis. Results Among 579 participants, 16.06% disclosed their HIV infection status to their male sexual partners. The effect of HIV disclosure on QOL was mediated by treatment self-efficacy. Self-efficacy played partial mediating role in social relationships, meaning that HIV disclosure had both direct and indirect effects on this factor. In the overall QOL and domains of physical, psychological, independence, and environment, HIV disclosure had an indirect effect only through self-efficacy and no significant effect on the spirituality domain. Conclusions The results emphasize the importance of HIV disclosure and self-efficacy on the QOL of MSM patients and suggest that health care providers should assist MSM patients in deciding whether to disclose their HIV status during daily medical services.

Abstract Background Consistent and complete adherence is considered an essential requirement for patients on antiretroviral therapy (ART). This study aimed to evaluate the impact of ART duration on ART adherence, identify the trend of complete adherence, and compare the factors associated with ART adherence between short-term and long-term ART group among men who have sex with men (MSM) living with HIV in Jinan of China. Methods MSM living with HIV aged 18 or above and currently on ART were recruited from October to December 2020 using convenience sampling. Univariate and multivariable logistic regressions were used to evaluate the impact of ART duration on adherence and compare factors associated with ART adherence between subgroups. The Mann–Kendall test was used to identify the trend of complete adherence. Results A total of 585 participants were included in analysis, consisting of 352 on short-term ART (ART initiation ≤ 3 years) and 233 on long-term ART (ART initiation > 3 years). Significant difference of complete ART adherence between short-term and long-term ART group was detected (79.8% vs. 69.1%, P = 0.003). Multivariable analysis showed that men with longer ART duration were less likely to report complete ART adherence (AOR = 0.88, 95% CI 0.81–0.95). A descending trend of complete adherence was identified (Z = 1.787, P = 0.037). Alcohol use and lack of medication reminders were barriers to complete adherence for both of the subgroups. Conclusions Sustained efforts to encourage maintaining adherence for a lifetime are necessary, especially for those on long-term ART. Future interventions should be tailored to subgroups with different ART duration and individuals with specific characteristics.

Abstract Background Antiretroviral therapy (ART) adherence is still suboptimal among some key populations, highlighting the need for innovative tailored strategies. This randomized controlled trial (RCT) aimed to evaluate the effect of a differentiated digital intervention on ART adherence among men who have sex with men (MSM) living with HIV in China. Methods The two-armed parallel RCT was conducted at one HIV clinic in Jinan of China from October 19, 2020, to June 31, 2021. Men were referred by health providers to join the study and then choose one of three digital strategies—text message, only instant message, or instant message plus social media. They were assigned in a 1:1 ratio to the intervention arm or control arm using block randomization, and inside each arm, there were three groups depending on the type of delivering the message. The groups were divided according to participants’ preferred digital strategies. The intervention arm received ART medication messages, medication reminders, peer education, and involved in online discussion. The control arm received messages on health behavior and nutrition. The primary outcome was self-reported optimal ART adherence, defined as not missing any doses and not having any delayed doses within a one-month period. Secondary outcomes included CD4 T cell counts, viral suppression, HIV treatment adherence self-efficacy, and quality of life. Intention-to-treat analysis with generalized linear mixed models was used to evaluate the intervention’s effect. Results A total of 576 participants were enrolled, including 288 participants assigned in the intervention arm and 288 assigned in the control arm. Most were ≤ 40 years old (79.9%) and initiated ART ≤ 3 years (60.4%). After intervention, the proportion of participants achieving optimal ART adherence in the intervention arm was higher than in the control arm (82.9% vs 71.1%). The differentiated digital intervention significantly improved ART adherence (RR = 1.74, 95%CI 1.21–2.50). Subgroup analysis showed one-to-one instant message-based intervention significantly improved ART adherence (RR = 2.40, 95% CI 1.39–4.17). Conclusions The differentiated digital intervention improved ART adherence among MSM living with HIV in China, which could be integrated into people living with HIV (PLWH) management and further promoted in areas where PLWH can access text messaging and instant messaging services. Trial registration ChiCTR2000041282. Retrospectively registered on 23 December 2020.

This study aims to explore how peer education influences men who have sex with men (MSM) to accompany friends to test and then affects their own testing, and to reveal the internal mechanism of peer education influencing HIV testing. A cross-sectional study among MSM in 11 cities in Shandong province, China was conducted to collect information on demographic characteristics, behavior, HIV-related knowledge, HIV testing history, and use of prevention services. Blood samples were tested for HIV status. Logistic regression was used for univariate and multivariate analyses, and R Mediation package was used for mediating effect analysis. Of 4,005 participants, 66.8% (2,674/4,005) had HIV testing in the last year, 50.6% (2,026/4,004) accompanied a friend for HIV testing, and 65.3% (2,614/4,005) received peer education in the last year. In multivariate logistic regression analysis, MSM who had anal sex with men in the past six months (adjusted odds ratio [AOR] = 1.772, 95% confidence interval [CI] = [1.438, 2.182]), had used drugs (AOR = 2.762, 95% CI = [2.264, 3.368]), received peer education in the past year (AOR = 2.412, 95% CI = [2.081, 2.796]), and accompanied a friend for testing in the past year (AOR = 3.077, 95% CI = [2.653, 3.569]) were more likely to take HIV testing. Receiving peer education in the past year could influence their own HIV testing in the past year by affecting their accompanying one’s friends to take the test in the past year (a*b = 0.889, 95% CI = [0.733, 1.053]). Peer education not only had a direct effect on HIV testing but also had an indirect effect on HIV testing by influencing accompanying friends for testing.

Abstract Background Men who have sex with men (MSM) are an important HIV key population in China. However, HIV testing rates among MSM remain suboptimal. Digital crowdsourced media interventions may be a useful tool to reach this marginalized population. We define digital crowdsourced media as using social media, mobile phone applications, Internet, or other digital approaches to disseminate messages developed from crowdsourcing contests. The proposed cluster randomized controlled trial (RCT) study aims to assess the effectiveness of a digital crowdsourced intervention to increase HIV testing uptake and decrease risky sexual behaviors among Chinese MSM. Methods A two-arm, cluster-randomized controlled trial will be implemented in eleven cities (ten clusters) in Shandong Province, China. Targeted study participants will be 250 MSM per arm and 50 participants per cluster. MSM who are 18 years old or above, live in the study city, have not been tested for HIV in the past 3 months, are not living with HIV or have never been tested for HIV, and are willing to provide informed consent will be enrolled. Participants will be recruited through banner advertisements on Blued, the largest gay dating app in China, and in-person at community-based organizations (CBOs). The intervention includes a series of crowdsourced intervention materials (24 images and four short videos about HIV testing and safe sexual behaviors) and HIV self-test services provided by the study team. The intervention was developed through a series of participatory crowdsourcing contests before this study. The self-test kits will be sent to the participants in the intervention group at the 2nd and 3rd follow-ups. Participants will be followed up quarterly during the 12-month period. The primary outcome will be self-reported HIV testing uptake at 12 months. Secondary outcomes will include changes in condomless sex, self-test efficacy, social network engagement, HIV testing social norms, and testing stigma. Discussion Innovative approaches to HIV testing among marginalized population are urgently needed. Through this cluster randomized controlled trial, we will evaluate the effectiveness of a digital crowdsourced intervention, improving HIV testing uptake among MSM and providing a resource in related public health fields. Trial registration ChiCTR1900024350 . Registered on 6 July 2019.

Abstract Background Community engagement strategies are often integrated in public health interventions designed to promote condom use among men who have sex with men (MSM), a key population for HIV prevention. However, the ways in which condom use peer norms and self-efficacy play a role in the association between community engagement and condom use is unclear. This study examines the potential mediating roles of peer norms and self-efficacy in this association. Methods A nationwide cross-sectional online survey was conducted among Chinese MSM in 2015. Recruitment criteria included being born biologically male, being older than 16 years, having had anal sex with a man at least once during their lifetime, and having had condomless anal or vaginal sex in the past three months. Mplus 6.11 was used to conduct confirmatory factor analysis and path modeling analysis to examine the structural relationships between HIV/sexual health community engagement (e.g., joining social media and community events related to HIV and sexual health services), condom use peer norms, condom use self-efficacy, and frequency of condom use. Results The study found that HIV/sexual health community engagement, condom use peer norms, condom use self-efficacy, and frequency of condom use were mutually correlated. A good data model was achieved with fit index: CFI = 0.988, TLI = 0.987, RMSEA = 0.032, 90% CI (0.028, 0.036). HIV/sexual health community engagement was associated with frequency of condom use, which was directly mediated by condom use peer norms and indirectly through self-efficacy. Conclusion The study suggests that condom use peer norms and self-efficacy may be mediators in the pathway between community engagement and condom use, and suggests the importance of peer-based interventions to improve condom use.

BACKGROUND:HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities. METHODS AND FINDINGS:An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval [CI] 2.2-15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95% CI 1.19-1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50-2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79-1.26), condom use (RR = 1.00, 95% CI 0.86-1.17), or syphilis testing (RR = 0.92, 95% CI 0.70-1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation. CONCLUSIONS:In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC). TRIAL REGISTRATION:ClinicalTrials.gov NCT02796963.

Migrant men who have sex with men (MSM) have a higher predisposition for HIV transmission. We aimed to determine and compare the prevalence and trends of HIV, Syphilis, and HCV between migrant and resident MSM in Shandong, China.A serial cross-sectional study was conducted in eight cities in Shandong, China from 2010 to 2014. The surveys collected information on demographics, HIV-related knowledge, and HIV-related behaviors including the serologic status of HIV, syphilis, and HCV. Bivariate and multivariable logistic regressions were used to determine differences between migrant and resident MSM.The overall prevalence of HIV among the 15,705 MSM (14120 were resident, 1580 were migrant and 5 were missing) was 2.6%, with an increase of 1.0% in 2010 to 4.4% in 2014. Prevalence of HIV was higher among migrant MSMs (5.5%) compared to resident MSMs (2.3%). Compared to residents, migrants also had higher prevalence of syphilis (7.5% vs 4.9%) and HCV (1.1% vs 0.6%). We found that there was an increase in the proportion of migrant MSM engaging in anal sex [adjusted OR (AOR) = 1.41 in migrants vs 1.12 in residents], condom use during last anal sex (AOR = 1.14 in residents, P for trend = 0.32), consistent condom use (AOR = 1.04 residents, P for trend = 0.11) and drug use (AOR = 1.51 in migrants and 1.29 among residents). Except in the year 2011, receiving some health services in last year was significant for people who were HIV-positive compared to negative. (P for trend

To assess the correlates for bisexual behaviors, HIV knowledge, and HIV/AIDS-related stigmatizing/discriminatory attitudes among men who have sex with men (MSM).A cross-sectional survey among MSM was conducted in 2011 to provide demographics, sexual behaviors, HIV knowledge, HIV/AIDS-related stigmatizing/discriminatory attitudes, and services in Jinan, Qingdao, and Yantai of Shandong Province of China.Of 1230 participants, 82.8% were single, 85.7% aged

BACKGROUND: Routine surveillance using convenient sampling found low prevalence of HIV and syphilis among female sex workers in China. Two consecutive surveys using respondent driven sampling were conducted in 2008 and 2009 to examine the prevalence of HIV and syphilis among female sex workers in Jinan, China. METHODS: A face-to-face interview was conducted to collect demographic, behavioral and service utilization information using a structured questionnaire. Blood samples were drawn for serological tests of HIV-1 antibody and syphilis antibody. Respondent Driven Sampling Analysis Tool was used to generate population level estimates. RESULTS: In 2008 and in 2009, 363 and 432 subjects were recruited and surveyed respectively. Prevalence of syphilis was 2.8% in 2008 and 2.2% in 2009, while no HIV case was found in both years. Results are comparable to those from routine sentinel surveillance system in the city. Only 60.8% subjects in 2008 and 48.3% in 2009 reported a consistent condom use with clients during the past month. Over 50% subjects had not been covered by any HIV-related services in the past year, with only 15.6% subjects in 2008 and 13.1% in 2009 ever tested for HIV. CONCLUSIONS: Despite the low prevalence of syphilis and HIV, risk behaviors are common. Targeted interventions to promote the safe sex and utilization of existing intervention services are still needed to keep the epidemic from growing.